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General NPI Number Information
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NPI Number | 1982979662
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Entity Type | Organization
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Legal Business Name | THERESA M HENDERSON, PA
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Dates
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Enumeration Date | 03/14/2012
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 1210 MILLENNIUM PKWY SUITE 1035
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City | BRANDON
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State | FL
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Zip | 33511-4861
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Country | US
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Telephone | 813-716-0585
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Fax | 813-814-0448
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Provider Business Mailing Address
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Address Line | 9609 WOODBAY DR
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City | TAMPA
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State | FL
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Zip | 33626-2422
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Country | US
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Telephone | 813-716-0585
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Fax | 813-814-0448
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. THERESA M HENDERSON
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Credential | LCSW
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Telephone | 813-716-0585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW2072
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License Number State | FL
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